Bed Bugs and Long-Term Care: Emerging Healthcare Issue

1
Bed Bugs and Long-Term CareEmerging Healthcare
Issue

• A primer for providers

By Erik Foster, MS Medical Entomologist Michigan
Department of Community Health
2
DISCLAIMER

• The following presentation presents a grim and
  often discouraging picture of a very unwelcome
  insect pest. However, bed bug management IS
  possible. Through education, training,
  cooperation, and persistence facilities can keep
  bed bugs at bay or at levels that are
  controllable.

3
What you will learn today

• Why are bed bugs a problem now?
• What are bed bugs?
• What are the health concerns with bed bugs?
• Can you tell if bed bugs are present?
• Provider guidance for bed bug prevention and
  control
• How to prevent bed bugs from going home with you
• Resources

4
Brief History of Bed Bugs

• The human bed bug is thought to have evolved from
  bat feeding relatives during the time early
  humans were living in caves
• There are dozens of species in the genus, most
  feeding on birds and bats

Early bed bug control method
5
Brief History of Bed Bugs

• Pre WWII estimates placed bed bug infestation
  rates in the U.S. as high as 1/3 homes
• Over the past 50 years, the human bed bug was
  rarely encountered in the U.S. due to
  improvements in living standards and the use of
  residual insecticides such as DDT

6
Media Frenzy -2010

• Drives public perception
• New York
• Theaters
• Clothing Stores
• Transportation
• Michigan
• High-rises in Detroit
• Public Housing
• Hospitals

7
Why the Resurgence?

• Bed bugs never truly went away
• Increases in global travel
• Lack of institutional knowledge due to rarity of
  bed bugs in the U.S.
• Reported resistance of bed bugs to currently used
  classes of insecticides
• Lack of public knowledge
• Expense of treatment

8
Are Bed Bugs a Public Health Issue? YES!

• Bed bugs are a HUMAN PARASITE they live ONLY on
  human blood
• Head lice and scabies are other examples of
  public health nuisance pests
• Measurable physical and mental health effects
  from prolonged infestations (CDC/EPA)
• Bed bugs are spread through human travel,
  contact, and commerce environmentally
  communicable
• Bed bugs often affect vulnerable populations
  disproportionately
• Citizens and agencies look to public health
  authorities for information and guidance on
  health issues

9
The Bed Bug ResurgencePest Management Survey

• Bed bug infestations are not required to be
  reported in most jurisdictions
• Survey of 950 pest management firms of various
  size worldwide
• The pest management industry provides valuable
  data on the distribution and trends of bed bug
  infestations

Potter et al. 2010
10
Frequency of Bed Bug Infestations Worldwide
Potter et al. 2010
11
Most Commonly Infested Locations
Potter et al. 2010
12
Public Concern
Potter et al. 2010
13
Perception of Government Officials
Potter et al. 2010
14
Bed Bug Emergence in Michigan

• First public health indication in 2006 Detroit
• WSU Mother brings in mattress left outside
• Noticeable increase in public concerns/complaints
  to MDCH beginning in 2008
• Realization of lack of available educational
  resources for local agencies
• Housing and tenant/landlord issues difficult to
  resolve
• MDCH acknowledgment that bed bugs are a public
  health issue

15
Public Health and Pest Management Industry
Findings
16
Risk Factors for a Bed Bug Infestation-Demographic

• Infestations primarily urban - for now
• Low-income rental housing
• Multi-unit rental housing
• Adult foster care facilities
• Long-term care facilities
• Homeless shelters
• Single family homes
• Hotels
• Schools and Childcare Facilities

17
Risk Factors for a Bed Bug Infestation-Behavioral

• Lack of knowledge about bed bugs!
• Acquiring Used Furniture/Bedding
• International and Domestic Travel
• Transient lifestyle
• Tenant/client fear of reporting infestations
• Institutional lack of protocol/proactive response

18
Biology of the Bed Bug

• Small - 3/16 inch long, oval, flat, reddish -
  brown insects
• Obligate human ectoparasite
• Nocturnally active, and feed almost painlessly
• Normally found within 5-20 feet of host
• Give off a distinctive musty, sweetish odor

FEMALE
MALE
19
Biology of the Bed Bug

• Undergo metamorphosis through 5 nymphal stages
  requiring a blood meal at each stage (feed within
  3-15 minutes)
• Life cycle takes 4-5 weeks (egg-to-egg) in good
  conditions 75-80 RH 83-90o F
• Female may lay 200-500 eggs in her lifetime
• Do not fly or jump

20
Life Cycle
Bed bugs progress through five stages. Optimal
conditions 5weeks egg to egg.
Unfed
Fed




21
Can be confused with
Tick

• Ticks
• Cockroach nymphs
• Other kinds of bug bites

Cockroach Nymph
Bat Bug
Other insect bites
22
Bed Bug Biology

• Sense and seek warmth and CO2
• Adults can survive gt1 yr. without feeding
  (Nymphs 3-4 mo.)
• Can remain fully active at lt45o F
• Prefer humans but feed on other hosts, too!
• Becoming resistant to many commonly available
  pesticides

23
Bed Bug Behavior

• Live indoors amongst our belongings
• Will infest cluttered AND pristine environments
• Easily hide in cracks, crevices in bed frames,
  mattresses, personal electronics, and baseboards,
  etc.
• Normally found within two meters of host
• Transmitted through the movement of people and
  their belongings
• Nocturnally active, attracted to heat and carbon
  dioxide
• Infestations can quickly build to extremely high
  levels due to rapid reproduction, difficulties in
  initial detection, and lack of knowledge about
  how to treat

24
Where bed bugs live

• In the building
• In any crack or crevice where a credit card edge
  could fit
• In anything near where people rest

Bed bug crawling into a screw hole to hide
Bed bugs using ceiling light fixture as harborage
24